CASE REPORT

A PATIENT WITH ACUTE STANFORD A DEBAKEY I AORTIC DISSECTION

WITH SUCCESSFUL BENTAL PROCEDURE AND HEMIARCH REPLACEMENT
Angela Bety Ratnasari12 , Mochamad Yusuf Asegaff12, Yan Efrata Sembiring34, Tinton
Pristianto12, Rendra Mahardhika Putra12
1
Departments of Cardiology and Vascular Medicine, dr. Soetomo Public Hospital, Indonesia
2
Departments of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
3
Departments of Thoracic and Cardiovascular Surgery, dr. Soetomo Public Hospital, Indonesia
4
Departments of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia

ABSTRACT
Introduction: Acute aortic dissection is an uncommon disorder which can have fatal
results in the event of treatment delay or misdiagnosis. Acute Debakey Type 1 aortic
dissection is a life threatening emergency and require immediate surgical intervention.
Although surgical techniques and perioperative care have significantly improved during
the decade, mortality remains high and is reported between 15% and 30%. For untreated
DeBakey type 1 aortic dissection, mortality increases up to 50% in the first 24 hours and
75% within two weeks after initial event.

Objective: To present a case of acute aortic dissection followed by successful bental and
hemiarch replacement surgery.

Case illustration: The 55-year-old man was presented to the emergency room after the
sudden onset of fainting and accompanied by chest pain radiating into the neck and back.
He was known had history of uncontrolled hypertension. On examination, patient was
had wide variation of blood pressure between arms, bradycardia, pulsus deficit, and
notable had a diastolic murmur at left parasternal border. Echocardiography revealed
flap and false lumen at aortic arch with diameter of ascending aorta was 59 mm,
sinotubular junction was 54 mm, valsava sinus 40 mm and aortic arch 25 mm. CT
Angiography revealed dissection of aortic thoracoabdominal from right subclavia artery,
bifucatio brachiocephalic a., left common carotid a. at level thyroid, aortic arch, aortic
ascending dan aortic descending. We controlled his blood pressure with amlodipine 10
and valsartan 80, and we admitted clopidogrel for antithrombotic and paracetamol to
relieve mild chest pain. He underwent surgery bental procedure and hemiarch
replacement immediately. The result of surgery is good, and the symptoms were relieve.

Discussion: Initial management of aortic dissection depends upon clinical presentation.

The primary goal is to reduce the force of left ventricular contraction without
compromising perfusion, thus reducing shear forces and preventing further extension of
the dissection or possible rupture. The agents that commonly used are IV nitroprusside
drip, IV labetalol, and calcium channel blockers . In this patient, we decided to use
amlodipine and valsartan to reduce his BP. Patient with acute type A aortic dissections
should be managed surgically in a regional cardiothoracic centre. Acute Type A aortic
dissection has a mortality of 50% within the first 48 hours if not operated. Dissections
involving the arch are more complicated than those involving only the ascending aorta,
because the innominate, carotid, and subclavian vessels branch from the arch

Conclusion: We reported patient with acute aortic dissection Stanford A Debakey I,

which can have fatal results in the event of treatment delay or misdiagnosis. Adequate
intial management and immediate surgery would improve mortality rate of this patient.

Keywords: aortic dissection, Stanford A, Debakey I, Bental procedure, Hemiarch

Replacement